Experts explain: Dr Maria Knöbel on medical cannabis and menopause

At Releaf we believe in empowering individuals to make their own informed choices about healthcare. Menopause can be a tricky time, and with the majority of women experiencing menopausal symptoms for an average of 7.4 years, it's important to find the right treatment. 

Yet, many aren’t aware medical cannabis may be one of these options. 

So, we sat down with Dr Maria Knöbel who is working towards recognition as a British Menopause Society Menopause Specialist to learn more.

Currently working for both the NHS and Releaf as an internationally board-certified Lifestyle Medicine GP, Dr Knöbel has lectured at The University of London, has peer-reviewed scientific journals, been published in medical text-books, and was recently interviewed by the organisers of Pause Live, the UK’s largest menopause event, about the potentials of medical cannabis menopause treatments. 

So, we scheduled in an interview too. Here’s what Dr Maria Knobel had to say:

Why is having alternative treatments for menopause important?

It’s always important to have alternatives in any area of healthcare. 

Speaking about menopause specifically, firstly, not everyone can have Hormone Replacement Therapy (HRT), but also, not everyone wants to have HRT. These two categories alone account for a surprising number of women. 

Some can't take HRT because they have significant clot risk, others might have different contraindications, such as a history of cancer, or very severe migraines or any of the other ‘red flags’ that make it unsafe for them, or at least, make the benefits of HRT not necessarily outweigh the risks. In these cases, we should start looking at alternatives. 

Then there's also the category of women who don't want HRT because they have had bad experience with it, or they had no relative who has, but frustratingly, aside from HRT, there weren't that many very effective treatments for the menopause until medical cannabis became available. 

Medical cannabis is not a direct treatment for menopause, but it can help with so many of the symptoms and challenges associated with menopause, when it’s applied appropriately.

How does medical cannabis interacts menopause symptoms?

The way I think about menopausal symptoms, or problems related to the menopause, is by breaking it down into the psychological symptoms and the physical symptoms that are systemic. Essentially, ‘whole body’ vs very specific physical concerns. 

So psychologically, we know mood, anxiety, irritability, and lack of energy is all to do with our hormonal swings, and during menopause the loss of the estrogen hormone, and that can be a huge problem for women. However, there are certain cultivars or ‘strains’ of cannabis that are particularly good at regulating mood and anxiety, which can be a fantastic benefit. 

When it comes to ‘whole body’ physical problems, things like vasomotor symptoms or hot flashes and night sweats, cannabis can help more indirectly. What I mean by this is it helps with what these night sweats or hot flushes can affect. 

For example, its very common for people struggle with sleep during menopause because of these symptoms, and while cannabis can interact with temperature regulation using the endocannabinoid system, its more directly benefits sleep regulation - typically minimising the amount of times a person wakes up throughout the night disturbed by these physical symptoms. 

Similarly, we’ve seen how helpful medical cannabis can be for women who deal with other issues during menopause, like skin conditions or dermatology concerns. For people with eczema, rosacea, psoriasis, it often gets worse in the menopause, and in cases like these, cannabis can play a role in reducing the inflammation that contributes to that. 

Other menopausal symptoms that are more localized, like vaginal dryness, or the wasting of the vaginal muscles, haven’t shown aren’t candidate symptoms for cannabis-based treatments, but other treatments that are not systemic, like HRT, can be very effective in these areas.

What considerations are taken into account when assessing suitability for menopause medical cannabis treatments?

At the moment, ​​there is no evidence to suggest that there is a contraindication between medical cannabis and HRT, or other natural, or holistic treatments for that matter. However, it's crucial that we evaluate a patient's entire health history before prescribing medical cannabis. 

At Releaf, we assess patient's medical records in their entirety before they even sit down with one of the team in a consultation. This is to make sure we have all the necessary health information, such as if the patient has a history of psychosis, or a recent cardiovascular disturbance, as well as a full understanding of which treatments they’ve previously tried in the past, and any medications they may be using on a daily basis. 

Often people think that when women start to experience perimenopausal symptoms they are no longer at risk of falling pregnant, but this is not true, so when a patient is seeking treatment to relieve perimenopausal symptoms, its also imperative that we also ensure they are not at risk of falling pregnant.

Another thing we take into consideration is the timeline. Although medical cannabis is fantastic at treating the menopausal symptoms we previously spoke about, unlike HRT, medical cannabis does not help with estrogen production and this is important to take into account. 

If patients aren’t able to take HRT and have turned to medical cannabis instead, they will have to take extra care of their bone health, and we can advise patients on the best ways to do this alongside cannabis-based treatments, such as incorporating more calcium into their diet and regularly exercising. 

Why is having broader conversations about women’s health and medical cannabis necessary?

Aside from the stigma around medical cannabis that we all know, I think what I find even more frustrating is how little research goes into women's health or problems that only affect women. 

But now it feels like now we finally have a spotlight on women’s health where we can discuss these issues and bring attention to them. For instance, female contraception procedures can be extremely painful, but, as standard, patients aren’t given pain relief. Meanwhile, any male procedure comes with pain relief. The more we talk about these issues, the more likely they are to change. 

After I qualified as a GP, one of the first practices I worked at had a lot of old school, very experienced, very talented GPs - but they were very fixed in their mindset on how to treat menopause, and I knew this was because their understanding was out of date.

Now, I sometimes find the same thing with cannabis. I can speak to GPs who have decades of experience but are not familiar with cannabis, and still hit this rigid thinking, but again, this is chalked down to misinformation. 

Thankfully, because of the efforts Releaf and other clinics are making, it's becoming more of a conversation again. Once medical cannabis is more widely available, I do see it becoming more of a common place adjunctive menopause treatment. The changes I’ve seen first hand have been astonishing, and I know how much of a difference this can make to those who need it most. 

Final Thoughts

If you’ve been wondering if medical cannabis might be right for you, or you’ve found traditional menopause treatments to be ineffective, head over to Releaf’s online eligibility checker to assess your suitability for these treatments. 

For more information about medical cannabis and women’s health, head over to our blog or education section to learn more.